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FOR OFFICE USE: <br /> ---------------------'y` <br /> ----- -------- -- --------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. .2�Df�- <br /> ---- --- ------- -- -- ------------------- ---- (Complete in Duplicate) <br /> -------------------- This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance'No. 549. <br /> t r , <br /> JOB ADDRESS AND LOCATION----- = -- - - ' y - � '..'.. <br /> r <br /> ---------- '! l /2-- ------------------------------- -------- --------- ----- Z?1 <br /> Owner's Name----- �-- - ------------------ Phone----•-----'Z--f--�- <br /> Address r I --- ---------------------------------------------- ------------------ <br /> W , <br /> 4 <br /> _ ;y11 <br /> Contractor's Name------_Sig 1_r !, -� Phone <br /> -------•------------------------------- <br /> Installation will.serve: Residen}e'El Apartment House�❑o. Commercial ❑ Trailer Court ❑ Motel ❑ Other 1 I <br /> Number.,of living units: _l---- Number of bedrooms _L---. Number of baths -_- `°Lot size ----2 f.� I <br /> S C?------------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private [ Depth to Water­Table 3-0 ft. <br /> Character of sail to a depth of 3 feet: Sand Gravel ❑ Sa dy Loam ❑ Clay L a 0 x Clay❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date--.---- ..__ _ ) No ET Construction: Yes V No ❑ FHA/VA: Yes ❑ No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: _, 3 I <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well--5_0------Distance from foundation---J.d_----__Mat vial.--_ ��'. � <br /> [ No. of compartments - -.-_Size-_-. � X__ -_-----Li Liquid th"-V,'.__--..._Ca pacify- _000- - <br /> p �.- _-- - q R - - p Y---- <br /> Disposal Field: Distance from nearest well----Sj 0',-Distance from foundation--------------------Distance to nearest to line---------- ------ <br /> Number of lines---------I.......................Length,of each line--------10-Uzi----- ---Width of trench.-- --;------._-- --------- <br /> Type of filter materi ....Depth of filter-materiai----6f-------------Total length- ------------------------ <br /> Seepage Pit: Distance to nearest-well----------------------Distance from><foundation--------------------Distance to nearest lot line-----..--..---..- <br /> ❑ Number of pits.:'-------------------Lining,rriate-rial-_`w"'------�-- --..Size: Diameter------------------.----Depth------.-------------------------- <br /> Cesspool: Distance from nearest,well-----------------Distance from fou dation........ <br /> A-------- Lining material---_------------------------------ <br /> --. <br /> ❑ Size: Diameter-------' �._..._Li uid Capacity 9als.�-------------------------De th - ----------- <br /> OF <br /> PrivY D�sfance from selDistance from nearest building----------=--- '--------------- ---------. <br /> ❑ Distance to nearestlot line ----------------------- -------------------- 1- -- ---,-------------------------------------------------- <br /> D <br /> r <br /> Remodeling and/or repairing (describe): _�" -----------{---------------- <br /> `pQ -d r - <br /> r------- ------t-------------------------------------------------------- <br /> �------ „ --- -- <br /> I hereby certify�fhat I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. k <br /> (Sign d '---- `--- ---------------------------------------------------------------------- ----(Owner and/or Contractor) <br /> B <br /> • (Title)- <br /> ----------- - --- -------- ---------- -------- ---- <br /> (Plot plan, showingtsize of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> 1 <br /> F DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- ----- -- ------ -------------------------------------- DATE = --------------------------- <br /> REVIEWED BY-----------------------------------_ --------------------------`--------------------------------- ---------------------- --- DATE----- -------------------------------------------------- <br /> BUILDING PERMIT ISSUED----------__-------------------------- -� ";--- ----•------------------ -------'--- DATEN------------------------------------------ <br /> Alterations and/or recommendations----------------------------------------------------------1;---------------------------------------------------------------------------------------------------- <br /> ------------- --------------------------------------------------------------------------------------------- -- ------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------- --------- --------------- ------- ---------------------------------- -------------------------------------------------------------- ------------- <br /> -------------------------------------- --------------------------------- -------------------- ------------------ ------------------------------------------------------------------ --- -- ------------------------------ <br /> FINAL INSPECTION BY:.__IV-_ ____ <br /> - ---------------------------------- Date-------- - ---------- ------ - --------------------------------- -------------- <br /> ( <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.RCO. <br /> 4 -xi <br />